Data processing for cost and price determinations with electronic negotiation

ABSTRACT

The embodiments disclose a data processing cost and price determination platform with electronic negotiation, including a mobile app configured to register a medical patient, a medical database configured to retrieve patient demographics, patient medical necessity codes and patient billed account data related to the medical patient of a medical provider, a server configured to electronically collect updated patient medical pricing data from governmental and health insurance carrier sources and medical necessity standards based on demographics of the medical provider, a processor configured to compare the patient billed account with the updated medical pricing data to determine a suggested fair market of the patient billed account, an electronic negotiation module to submit the suggested fair market of the patient billed account data to the medical provider for soliciting a negotiated settlement rate and a communication module to transmit the accepted negotiated settlement rate from the medical provider to the medical patient.

CROSS-REFERENCED TO RELATED APPLICATIONS

This patent application is a continuation-in-part application based onpending U.S. Non-Provisional application Ser. No. 14/296,650 filed Jun.5, 2014, entitled “WEB-BASED AUTOMATED BILL NEGOTIATION SYSTEM”, byGregory J. Hummer, the U.S. patent application being incorporated hereinby reference.

BACKGROUND

Data processing is used to collect the data and translate and analyzethe data into usable information. Electronic negotiation is a method ofallowing negotiations via electronic communications. Many forms of dataprocessing involve a manual process to setup the data.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a system for data processing cost and pricedetermination with electronic negotiation, in accordance with variousaspects set forth herein of one embodiment.

FIG. 2 illustrates a method for automated bill negotiation in accordancewith various aspects described herein of one embodiment.

FIG. 3 illustrates a screenshot of a user interface of the automateddata processing cost and price determination with electronic negotiationthat is presented to a user, in accordance with various aspects setforth herein of one embodiment.

FIG. 4 illustrates another screenshot of a user interface of theautomated data processing cost and price determination with electronicnegotiation that is presented to a user, in accordance with variousaspects set forth herein of one embodiment.

FIG. 5 shows a block diagram of an overview of an electronic negotiationmobile app of one embodiment.

FIG. 6 shows a block diagram of an overview of a patient financialhardship questionnaire of one embodiment.

FIG. 7 shows a block diagram of an overview of categorized providerstatus of one embodiment.

FIG. 8 shows a block diagram of an overview of medical pricing of oneembodiment.

FIG. 9 shows a block diagram of an overview of prescription pricing ofone embodiment.

DETAILED DESCRIPTION OF THE INVENTION

In a following description, reference is made to the accompanyingdrawings, which form a part hereof, and in which is shown by way ofillustration a specific example in which the invention may be practiced.It is to be understood that other embodiments may be utilized, andstructural changes may be made without departing from the scope of thepresent invention.

General Overview:

It should be noted that the descriptions that follow, for example, interms of a data processing for cost and price determinations withelectronic negotiation are described for illustrative purposes and theunderlying system can apply to any number and multiple types ofbillings. In one embodiment of the present invention, the dataprocessing for cost and price determinations with electronic negotiationcan be configured using an electronic negotiation mobile app. The dataprocessing for cost and price determinations with electronic negotiationcan be configured to include at least one remote server database and canbe configured to include at least one remote server processor using thepresent invention.

According to one aspect, a data processing for cost and pricedeterminations with electronic negotiation facilitates negotiating apatient's bill owed to a medical provider comprises a processor thatexecutes computer-executable instructions for calculating a settlementamount on the patient's balance bill owed to the medical provider or mayoffer a prospective amount to the medical provider on behalf of thepatient, therewith and a memory device 16 that stores thecomputer-executable instructions.

The data processing for cost and price determinations with electronicnegotiation platform further includes a data processing for cost andprice determinations with electronic negotiation server comprising aprocessor and a memory device and providing Internet access to theprocessor for calculating the settlement amount. The instructionscomprise receiving patient billing information, calculating a settlementamount associated with the bill owed or an amount prospectively for theprocedure to be owed to the medical provider from the patient billinginformation, electronically communicating the settlement amount to theassociated medical provider, determining whether the medical provideraccepted or declined the settlement amount, informing the patient andcharging a service fee if the medical provider accepted the settlementamount, calculating a second settlement amount if the medical providerdeclined the settlement amount, electronically communicating the secondsettlement amount to the associated medical provider, determiningwhether the medical provider accepted or declined the second settlementamount, informing the patient and charging a service fee if the medicalprovider accepted the second settlement amount, and updating a billstatus based on the determination of the first and second settlementamounts.

In accordance with various features described herein, systems andmethods are described that facilitate the negotiation of a medical billfor an individual (e.g., patients and their family members, insurancecustomers, and their family members, etc.) via a web-based cloudapplication that automatically calculates the best settlement offer forthe individual's bills. As used herein, “algorithm” or “module” refersto a set of computer-executable instructions stored on acomputer-readable medium and executable by a processor or othercomputing device, as will be appreciated by those of skill in the art.

The terms data processing cost and price determination with electronicnegotiation, data processing cost, and price determination withelectronic negotiation are used interchangeably without any change inmeaning.

Graphical User Interface:

With reference to FIG. 1 , a system 10 is illustrated that facilitatesproviding the herein-described data processing cost and pricedetermination with electronic negotiation, e.g., via a graphical userinterface (GUI) 11. The system 10 includes a data processing cost andprice determination with electronic negotiation 13 server 12 with ananalyzer 15 and a processor 14 that executes, and a memory device 16that stores, computer-executable instructions for performing the variousfunctions, methods, techniques, algorithms, etc., described herein. Theserver 12 is coupled to the Internet 18, by which it communicates withan electronic negotiation mobile app 32, accesses, etc., the GUI 11 of,for example, at least one device from a group consisting of a patient'spersonal computer, laptop, tablet, patient smartphone 34,

Additionally, the server 12 can access a database 20 that stores userprofiles 21 comprising patient billing information 22. The patientbilling information 22 includes patient information 24 (e.g., patientname, patient contact information, medical provider 50, medical providercontact information, insurance carrier, insurance carrier accountinformation, patient payment information, etc.) and billing information26 (e.g., invoice number, bill amount, patient balance, date of service,negotiated amount to pay, status of the bill, due date, etc.). Thedatabase 20 also stores updates of the provider status 40 and medicalprices and treatment qualifying conditions 42.

The patient billing information 22 may be entered by the user (e.g., viathe GUI) or may be medical record data that the user has authorized tobe made available to a provider of the automated bill negotiation.Although depicted as being stored in a database 20 coupled to the GUIand server 12 via the internet 18, the user profile can reside on theuser's GUI 11 or at any other suitable location (e.g., the server 12, aremote server 12, or computer-readable storage device, etc.). In anotherembodiment, the database 20 is a distributed database, and/or the server12 is a distributed server 12.

The patient billing information 22 is uploaded to, or retrieved by, theserver 12 and loaded into a data processing cost and price determinationwith electronic negotiation 13 and electronic negotiation module 28stored in the memory device 16. The electronic negotiation module 28utilizes the patient billing information 22 to automatically secure asettlement or discount on the patient's balance bill owed to a medicalprovider 50. Specifically, the data processing cost and pricedetermination with electronic negotiation 13 uses the electronicnegotiation module 28 to calculate a settlement amount associated foreach bill included in the patient billing information 22 to provide thegreatest chance of success to decrease the amount owed to the medicalprovider 50.

The settlement amount is then communicated to the medical provider 50whom either accepts or declines the settlement amount, by clicking onAccept or Decline within the email, which then automatically updates theserver database 20 immediately or by e-faxing the offer back to theserver 12. If the medical provider 50 accepts the settlement amount, thepatient is then charged by the data processing cost and pricedetermination with electronic negotiation 13 electronic negotiationmodule 28 for the settlement amount. If the settlement amount isdeclined, the negotiation calculates another settlement amount which iscommunicated to the medical provider 50.

To accomplish this, a patient initially inputs billing information 26for a bill owed to a medical provider 50 utilizing the GUI 11 of thepatient smartphone 34. Along with the billing information 26, thepatient inputs patient information 24 including payment information suchas credit card information or checking account information is enteredusing the electronic negotiation mobile app 32. In another embodiment,the payment information comprises online payment service accountinformation such as a PayPal™ account or the like. After the patient'sbilling and patient information have been entered, the electronicnegotiation module 28 utilizes a negotiation algorithm to calculate thebest settlement amount to offer the medical provider. For example, theelectronic negotiation module 28 will calculate the settlement amountutilizing a percentage of the owed amount for each bill. In anotherembodiment, the electronic negotiation module 28 determines thesettlement amount utilizing a negotiation table which stores optimalsettlement amounts for various balance amounts utilizing one or morelookup tables (LUTs) 30. In another embodiment, the settlement amountcan be user-entered values.

After the electronic negotiation module 28 determines a settlementamount for a particular bill, the electronic negotiation module 28transmits an electronic communication (email, fax, automated voice phonecall, etc.) which enables the medical provider to accept or decline thesettlement amount. For example, an electronic mail message is sent tothe medical provider with a clickable link that includes accept ordecline fields. Clicking on the accept or decline link within the emailautomatically updates the bill's status with the medical provider'sresponse and, if accepted, directs the medical provider to anotherwebsite to sign the settlement amount with a dated time stamp which isstored in the patient billing information 22. If the medical providerdoes not have an electronic mail account, the electronic negotiationmodule 28 transmits an electronic fax message to the medical provider'sfax machine. The medical provider indicates on the transmitted documentwhether the settlement amount is accepted or declined and faxes thedocument back to the electronic negotiation module 28. The electronicnegotiation module 28 utilizes one or more word or image recognitionalgorithms (e.g., optical character recognition or some other suitablealgorithm) to determine whether the settlement amount was accepted ordeclined which is updated on the bill's status.

After a settlement amount is accepted by the medical provider, thepatient is electronically informed by electronic mail and has apredetermined time to pay the medical provider the settlement amount. Ifthe settlement amount is accepted by the medical provider, the patientis charged a service fee for the service provided. The service fee caninclude a one-time fee, a percentage of the settlement amount, and thelike. If the settlement amount is declined by the medical provider, thepatient is informed electronically and the electronic negotiation module28 calculates a second settlement amount via the negotiation algorithm,look-up table, or user-input which is communicated to the medicalprovider. If the medical provider declines the second settlement amount,the patient is informed once again and is not charged the service fee.

As previously mentioned, the system 10 comprises the processor 14 thatexecutes, and the memory device 16 that stores, computer-executableinstructions and/or computer-readable data (e.g., a software package orproduct) for performing the various techniques and/or methods describedherein. The memory device 16 may be a computer-readable recording mediumon which a control program or software product is recorded, such as adisk, hard drive, or database 20. Common forms of computer-readablemedia include, for example, floppy disks, flexible disks, hard disks,magnetic tape, or any other magnetic storage medium, CD-ROM, DVD, or anyother optical medium, a ROM, a PROM, an EPROM, a FLASH-EPROM, or othermemory chip or cartridge, or any other tangible medium from which acomputer can read and use. Alternatively, the methods may be implementedin a transmittable carrier wave in which the control program is embodiedas a data signal using transmission media, such as acoustic or lightwaves, such as those generated during radio wave and infrared datacommunications, and the like.

Data Processing for Price and Electronic Negotiation of Patient's BillOwed:

FIG. 2 illustrates a method related to automatically negotiating asettlement amount for a patient's bill owed to a medical provider, inaccordance with various features. While the method is described as aseries of acts, it will be understood that not all acts may be requiredto achieve the described goals and/or outcomes, and that some acts may,in accordance with certain aspects, be performed in an order differentthan the specific orders described. The method of FIG. 2 may beimplemented on a computer 200, as described below. Additionally, it willbe appreciated that the method of FIG. 2 may be performed separately orin conjunction with each other.

FIG. 2 illustrates a method for automated bill negotiation, such as canbe performed by the system of FIG. 1 , in accordance with variousaspects described herein. At 100, patient information (e.g., patientname, patient contact information, medical provider, medical providercontact information, insurance carrier, insurance carrier accountinformation, patient payment information, etc.) and billing information(e.g., invoice number, bill amount, patient balance, date of service,negotiated amount to pay, status of the bill, due date, etc.) arereceived or retrieved. The information is stored in a user profile forthe user on a computer-readable medium, at 102. At 104, a negotiationalgorithm is executed to calculate a settlement amount (e.g., a dollaramount, or some other currency amount) associated with a bill owed to amedical provider. At 106, the settlement amount is electronicallycommunicated to the medical provider. At 108, it is determined whetherthe medical provider accepted or declined the settlement amount. If itis determined that the medical provider accepted the settlement amount,the patient is informed, and the bill status is updated at 110. At 112,the patient is charged a service fee. If it is determined that themedical provider declined the settlement amount, the patient isinformed, and the bill status is updated at 114. At 116, a secondsettlement amount associated with the bill is calculated andcommunicated to the medical provider. At 118, it is determined whetherthe medical provider accepted or declined the second settlement amount.If it is determined that the medical provider accepted the secondsettlement amount, the patient is informed, and the bill status isupdated at 120. At 122, the patient is charged a service fee. If it isdetermined that the medical provider declined the second settlementamount, the patient is informed, and the bill status is updated at 124.The method thus provides a bill negotiation tool that is automated andprovides the best settlement offer for reducing a patient's bill owed toa medical provider.

The method illustrated in FIG. 2 may be implemented in a computerprogram product that may be executed on a computer 200 or processor suchas the processor 14 in the system of FIG. 1 . Further, it is to beappreciated that any suitable computing environment can be employed inaccordance with the present embodiments. For example, computingarchitectures including, but not limited to, stand-alone,multiprocessor, distributed, client/server, minicomputer, mainframe,supercomputer, digital, and analog can be employed in accordance withthe present embodiments.

The computer can include a processing unit such as the processor 16 ofFIG. 1 , a system memory such as the memory device 16 of FIG. 1 , and asystem bus that couples various system components including the systemmemory to the processing unit. The processing unit can be any of variouscommercially available processors (e.g., a central processing unit, agraphical processing unit, etc.). Dual microprocessors and othermulti-processor architectures also can be used as the processing unit.

The system bus can be any of several types of bus structure including amemory bus or memory controller, a peripheral bus, and a local bus usingany of a variety of commercially available bus architectures. Thecomputer memory device 16 includes read-only memory (ROM) andrandom-access memory (RAM). A basic input/output system (BIOS),containing the basic routines that help to transfer information betweenelements within the computer, such as during start-up, is stored in ROM.

The computer can further include a hard disk drive, a magnetic diskdrive, e.g., to read from or write to a removable disk, and an opticaldisk drive, e.g., for reading a CD-ROM disk or to read from or write toother optical media. The computer typically includes at least some formof computer-readable media. Computer-readable media can be any availablemedia that can be accessed by the computer. By way of example, and notlimitation, computer-readable media may comprise computer storage mediaand communication media. Computer storage media includes volatile andnonvolatile, removable and non-removable media implemented in any methodor technology for storage of information such as computer-readableinstructions, data structures, program modules, or other data. Computerstorage media includes, but is not limited to, RAM, ROM, EEPROM, flashmemory or other memory technology, CD-ROM, digital versatile disks (DVD)or other magnetic storage devices, or any other medium which can be usedto store the desired information, and which can be accessed by thecomputer.

Communication media typically embodies computer-readable instructions,data structures, program modules, or other data in a modulated datasignal such as a carrier wave or other transport mechanism and includesany information delivery media. The term “modulated data signal” means asignal that has one or more of its characteristics set or changed insuch a manner as to encode information in the signal. By way of example,and not limitation, communication media includes wired media such as awired network or direct-wired connection, and wireless media such asacoustic, RF, infrared, and other wireless media. Combinations of any ofthe above can also be included within the scope of computer-readablemedia.

A number of program modules may be stored in the drives and RAM,including an operating system, one or more application programs, otherprogram modules, and program non-interrupt data. The operating system inthe computer can be any of a number of commercially available operatingsystems.

A user may enter commands and information into the computer through akeyboard (not shown) and a pointing device or stylus (not shown), suchas a mouse. Other input devices (not shown) may include a microphone, anIR remote control, a joystick, a game pad, a satellite dish, a scanner,or the like. These and other input devices are often connected to theprocessing unit through a serial port interface (not shown) that iscoupled to the system bus, but may be connected by other interfaces,such as a parallel port, a game port, a universal serial bus (USB), anIR interface, etc.

A monitor (not shown), or other types of display devices, may also beconnected to the system bus via an interface, such as a video adapter(not shown). In addition to the monitor, a computer typically includesother peripheral output devices (not shown), such as speakers, printers,etc. The monitor can be employed with the computer to present data thatis electronically received from one or more disparate sources. Forexample, the monitor can be an LCD, plasma, CRT, etc. type that presentsdata electronically. Alternatively, or in addition, the monitor candisplay received data in a hard copy format such as a printer,facsimile, plotter, etc. The monitor can present data in any color andcan receive data from the computer via any wireless or hard wireprotocol and/or standard.

The computer can operate in a networked environment using logical and/orphysical connections to one or more remote computers, such as a remotecomputer(s). The remote computer(s) can be a workstation, a servercomputer, a router, a personal computer, a microprocessor-basedentertainment appliance, a peer device, or other common network nodes,and typically includes many or all of the elements described relative tothe computer. The logical connections depicted include a local areanetwork (LAN) and a wide area network (WAN). Such networkingenvironments are commonplace in offices, enterprise-wide computernetworks, intranets, and the Internet.

When used in a LAN networking environment, the computer is connected tothe local network through a network interface or adapter. When used in aWAN networking environment, the computer typically includes a modem, oris connected to a communications server on the LAN, or has other meansfor establishing communications over the WAN, such as the Internet. In anetworked environment, program modules depicted relative to thecomputer, or portions thereof, may be stored in the remote memory device16. It will be appreciated that network connections described herein areexemplary and other means of establishing a communications link betweenthe computers may be used.

Automated Bill Negotiation:

FIG. 3 illustrates a screenshot of a user interface 300 of the automatedbill negotiation that is presented to a user, in accordance with variousaspects set forth herein. The user interface 300 includes a personalinformation field 302 in which information that is entered and/orpresented is displayed including but not limited to patient name,medical provider name, and insurance carrier. The user interface 300also includes a billing information field 304 in which information thatis entered and/or present is displayed including but not limited toinvoice number, bill amount, patient balance, date of service,negotiated amount to pay, status of the bill, and due date.

User Interface:

FIG. 4 illustrates another screenshot of a user interface 400 of theautomated bill negotiation that is presented to a user, in accordancewith various aspects set forth herein. The user interface 400 displaysthe patient information field 402 and billing information field 404 fora particular bill associated with a patient. The personal informationfield 402 includes but is not limited to patient name, medical providername, and insurance carrier, and the billing information field 404includes but is not limited to invoice number, bill amount, patientbalance, date of service, negotiated amount to pay, status of the bill,and due date. The user interface 400 also includes the settlement amountto be paid 406 and a service fee amount status 408. The user interface400 also includes an auto calculate icon 410 which enables the user tohave the automated bill negotiation automatically calculate thesettlement amount to be presented to the medical provider.

Electronic Negotiation Mobile App:

FIG. 5 shows a block diagram of an overview of an electronic negotiationmobile app of one embodiment. FIG. 5 shows the data processing cost andprice determination with electronic negotiation 13 communicating data tothe electronic negotiation mobile app 32 on which a patient registers asa member 502. The patient enters medical provider billing information510. The patient enters the patient identification information 520.

The data processing cost and price determination with electronicnegotiation 13 updates over the internet 18 of FIG. 1 medical prices andtreatment qualifying conditions 42 of FIG. 1 and records the data on thedatabase 20. The patient enters any member financial hardshipcircumstances 530. Descriptions continue on FIG. 6 . The electronicnegotiation mobile app 32 is wirelessly coupled to a remote server 540.The remote server 540 includes at least one database 20. At least onedatabase 20 stores member profile database records 542. The dataprocessing cost and price determination with electronic negotiation 13automatically queries the patient electronic health records for billinginformation 550. The electronic negotiation module downloads the patiententered and electronically retrieved billing information 560.

The remote server 540 includes at least one processor 570. At least oneprocessor 570 coupled to the electronic negotiation module 28 of FIG. 1. The electronic negotiation module identifies unpaid or partiallyunpaid provider billing 572. The electronic negotiation modulecategorized unpaid or partially unpaid provider billings 580 are furthercategorized with the provider status 40. The provider status 40 includesin network 591 and out of network 592. The provider status 40 impacts ona patient's billing are described in FIG. 7 . The patient's providerbillings include procedures 593. The provider status 40 impacts thecosts of provider procedures 593 is described in FIG. 8 . The patient'sprovider billings include lab testing 594. The provider status 40 impacton the costs of provider lab testing 594 orders is described on FIG. 8 .The provider's prescriptions 595 written for the patient, has a bigimpact on the medical costs for the patient. Descriptions continue onFIG. 9 of one embodiment.

Patient Financial Hardship Questionnaire:

FIG. 6 shows a block diagram of an overview of a patient financialhardship questionnaire of one embodiment. FIG. 6 shows a continuationfrom FIG. 5 . The system automatically displays a patient financialhardship questionnaire during the member registration 600. The patiententers any member financial hardship circumstances on the financialhardship questionnaire 610. Financial hardship questionnaire 620. Thesystem automatically records and analyzes user financial hardshipinformation 630. Automatically prepares and sends a financial hardshipletter to the provider 640 of one embodiment.

Categorized Provider Status:

FIG. 7 shows a block diagram of an overview of the categorized providerstatus of one embodiment. FIG. 7 shows a continuation from FIG. 5 . Theelectronic negotiation module categorized provider status 700 includesat least in-network providers 710, out-of-network providers 720, and theprovider geographic region 702.

The electronic negotiation module automatically downloads updatedin-network providers 710 network medical prices 730 and compares thoseto out-of-network provider medical prices billed to patient 740. Theelectronic negotiation module algorithm analysis of any pricedifferences 750. Updated medical pricing is collected from at least oneinsurance carrier medical fee schedule, at least one governmentalmedical fee schedule, and other medical fee schedules 752. Networkmedical rates are used to calculate out-of-network provider billingadjustments 760. The electronic negotiation module includes the lowernetwork prices in a best settlement offer for a patient's bills 770. Theelectronic negotiation module automatically prepares a settlement offerletter to the provider including the in-network/out-of-network reducedprices 780 of one embodiment.

The electronic negotiation module 28 of FIG. 1 includes a review of theprovider billings compliance with local, state, and federal regulationsand requirements for providers and facilities. The electronicnegotiation module 28 of FIG. 1 determines if the provider gave thepatient a required good faith estimate. If the provider conveyed a goodfaith estimate are the estimate charges substantially in excess of thegood faith estimate. The electronic negotiation module 28 of FIG. 1discounts the provider billing by any excess greater than the good faithestimate.

The federal regulations and requirements for providers and facilitiesprohibit providers and facilities from directly billing individuals forthe difference between the amount they charge and the amount that theindividual's plan or coverage will pay plus the individual'scost-sharing amounts in a process referred to as balance billing. Theelectronic negotiation module 28 of FIG. 1 discounts the providerbilling by any balance billing amounts determined with the remote server540 of FIG. 5 at least one processor 570 of FIG. 5 . The federalregulations and requirements for providers and facilities limit billedamounts in situations where a provider's network status changesmid-treatment. The electronic negotiation module 28 of FIG. 1 discountsprovider billed amounts to in-network amounts should the provider statuschange to out-of-network.

Medical Pricing:

FIG. 8 shows a block diagram of an overview of medical pricing of oneembodiment. FIG. 8 shows a continuation from FIG. 5 . Medical procedures800 and lab testing 810 are compared with local coverage determinations(LCDS) medical pricing and medical necessity conditions are downloadedvia the internet 820. The electronic negotiation module algorithmcompares the medical necessity provider filings to LCDS medicalnecessity conditions to determine justification for the provider'sprocedures and lab testing orders 830. The electronic negotiation modulealgorithm compares the provider billing prices against the LCDS pricesfor procedures and lab testing 840. If the provider's medical necessityis not supported by the LCDS medical necessity conditions the providerbilling amount is fully discounted 850. If the provider medicalnecessity is supported by the LCDS medical necessity conditions theprovider billing amount is discounted to the lower LCDS amount 860. LCDSmedical rates are used to calculate provider procedures and lab testingorders differences with the LCDS medical rates for provider billingadjustments.

The electronic negotiation module 28 of FIG. 1 automatically updatesmedical codes pricing constantly from the internet by researchinggovernment healthcare programs fee schedules, insurance carriers medicalfee schedules, and other valid sources for medical pricing. The CurrentProcedural Terminology (CPT®) set of medical codes, Healthcare CommonProcedure Coding System (HCPCS) Level II codes, InternationalClassification of Diseases Procedure Coding System (ICD-10-PCS) codes,International Classification of Diseases Clinical Modification(ICD-10-CM) codes used by physicians, allied health professionals,nonphysician practitioners, hospitals, outpatient facilities, andlaboratories to describe the procedures and services they perform.

Health insurance carriers create their medical fee schedules accordingto a calculation called a “reasonable and customary” fee. The reasonableand customary fee is a calculation according to the prevailing averagecost of each service within a geographic region. Many physicians, alliedhealth professionals, non-physician practitioners, hospitals, outpatientfacilities, and laboratories set their fees with a calculation thatproduces a price that is 1.5 to 2 times for each CPT® code based onMedicare's fee schedule.

The electronic negotiation module 28 of FIG. 1 automatically comparesthe patient-provider billing amount to the Medicare CPT® code feeschedule to determine the provider's fee amount overcharge from theMedicare CPT® code fee schedule. A reasonable and customary fee within ageographic region is compared to the provider billing amount 842. Thecomparison determines if the provider billing amount is greater or lessthan the prevailing average cost within the provider geographic region702 of FIG. 7 . The electronic negotiation module compares the lowerLCDS prices and reasonable and customary fees prevailing averagecost-adjusted price. The lower of the two compared prices is used in abest settlement offer 845. The electronic negotiation module includesthe lowest price in a best settlement offer for a patient's bills 880.The electronic negotiation module automatically prepares a settlementoffer letter to the provider including the lowest reduced prices 890 ofone embodiment.

Prescription Pricing:

FIG. 9 shows a block diagram of an overview of prescription pricing ofone embodiment. FIG. 9 shows a continuation from FIG. 5 . Prescriptionpricing and medical necessity conditions are downloaded via the internet900. Generic prescription medications 910 are compared to name-brandprescription medications 920. The FDA states generic medications cancost, on average, 80 to 85 percent less than the brand-name equivalents930. The electronic negotiation module algorithm compares the costs ofname-brand prescription medications versus generic prescriptionmedications 940. If the provider medical necessity does not supportprescribing name-brand medications the provider billing amount isdiscounted by the difference in costs with a generic equivalentmedication 950. If the provider ordered generic prescription medicationsfor the patient, then no adjustment is made for prescribed medicationsin the provider billing 960.

The electronic negotiation module includes the generic prescriptionsmedications prices difference in a best settlement offer patient creditfor a patient's bills 970. The electronic negotiation moduleautomatically prepares a settlement offer letter to the providerincluding the generic reduced prices 980 of one embodiment. Thename-brand medications unsupported prescription is not billed to thepatient by the provider. However, the unsupported requirement of thename-brand medications has cost the patient an extra expense. Thedifference is applied as a credit to the balance of the patient'sprovider billing amounts as the name-brand medications could not bejustified of one embodiment.

The foregoing has described the principles, embodiments, and modes ofoperation of the present invention. However, the invention should not beconstrued as being limited to the particular embodiments discussed. Theabove-described embodiments should be regarded as illustrative ratherthan restrictive, and it should be appreciated that variations may bemade in those embodiments by workers skilled in the art withoutdeparting from the scope of the present invention as defined by thefollowing claims.

What is claimed is:
 1. A data processing cost and price determinationplatform with electronic negotiation, comprising: a mobile appconfigured to register a medical patient with unique patient data; amedical database coupled to the mobile app and configured to retrievepatient demographics, patient medical necessity codes, and billedmedical services patient account data related to the registered medicalpatient of a medical provider; a server coupled to the medical databaseconfigured to electronically collect updated patient medical pricingdata from governmental and health insurance carrier medical fee schedulesources and medical necessity standards based on demographics of themedical provider; a processor coupled to the server configured tocompare the patient billed account data with the updated medical pricingdata and to compare the medical necessity standards to the patientmedical necessity codes to determine a suggested fair market value ofthe billed medical services; an electronic negotiation module coupled tothe processor configured to submit the unique patient data and thesuggested fair market value of the billed medical services to themedical provider for soliciting a negotiated settlement rate from themedical provider that is less than the billed medical services; and acommunication module coupled to the electronic negotiation moduleconfigured to transmit the negotiated settlement rate from the medicalprovider to the medical patient.
 2. The data processing cost and pricedetermination platform with electronic negotiation of claim 1, whereinupdated medical pricing data includes at least one commercial insurancecarrier medical fee schedule and at least one governmental medical feeschedule.
 3. The data processing cost and price determination platformwith electronic negotiation of claim 1, wherein the updated medicalpricing data includes health insurance carriers reasonable and customaryfee data based on a prevailing average cost of each service within amedical provider geographic region.
 4. The data processing cost andprice determination platform with electronic negotiation of claim 1,wherein the updated medical pricing data includes government based localcoverage determinations (LCDs) medical pricing, and medical necessityconditions.
 5. The data processing cost and price determination platformwith electronic negotiation of claim 1, wherein the unique patient dataincludes patient financial hardship questionnaire responses.
 6. The dataprocessing cost and price determination platform with electronicnegotiation of claim 1, wherein the unique patient data includes apatient's financial hardship letter to be included in negotiatedsettlement rate.
 7. The data processing cost and price determinationplatform with electronic negotiation of claim 1, wherein the patientmedical necessity codes include International Classification of Diseases(ICD) diagnosis codes.
 8. A data processing platform, comprising: amobile app configured to collect directly from a patient demographicinformation and unique patient financial data and to retrieve directlyfrom an electronic health record (EHR) of a medical provider billedmedical services account data of the patient and associated medicalbilling codes and medical necessity codes; a server coupled to themobile app configured to collect updated patient medical pricing datafrom governmental and health insurance carrier sources and medicalnecessity standards based on demographics of the medical provider; aprocessor coupled to the server configured to compare the patient billedaccount data with the updated medical pricing data and to compare themedical necessity standards to the patient billing and medical necessitycodes to determine a suggested fair market value of the billed medicalservices of the patient account data; and an electronic negotiationmodule coupled to the processor configured to submit the unique patientdata and the suggested fair market value of the billed medical servicespatient account data to the medical provider for soliciting a negotiatedsettlement rate from the medical provider that is less than the billedmedical services of the patient account data.
 9. The data processingplatform of claim 8, wherein updated medical pricing data includesmedical necessity justification according to accepted updated medicaldata for medical provider services and prescriptions.
 10. The dataprocessing platform of claim 8, wherein updated medical pricing dataincludes a governmental medical fee schedule and a commercial medicalfee schedule.
 11. The data processing platform of claim 8, wherein theupdated medical pricing data includes health insurance carrierreasonable and customary fee data based on a prevailing average cost ofeach service within a medical provider geographic region.
 12. The dataprocessing platform of claim 8, wherein the updated medical pricing dataincludes local coverage determinations (LCDs) medical pricing andmedical necessity conditions.
 13. The data processing platform of claim8, wherein the unique patient data includes patient financial hardshipquestionnaire responses.
 14. The data processing platform of claim 8,wherein the patient custom data includes a patient's financial hardshipletter to be included in negotiated settlement rate.
 15. A dataprocessing cost and price determination platform, comprising: a mobileapp configured to collect directly from a patient demographicinformation and unique patient financial hardship data; an integrationmodule configured to retrieve directly from an electronic health record(EHR) of a medical provider billed medical services account data of thepatient and associated medical billing codes and medical necessitycodes; a server coupled to mobile app and configured to collect updatedpatient medical pricing data from governmental and health insurancecarrier sources and medical necessity standards based on demographics ofthe medical provider; a processor coupled to the server and configuredto compare the patient billed account data with the updated medicalpricing data and to compare the medical necessity standards to thepatient billing and medical necessity codes to determine a recommendedfair market value of the billed medical services; an electronicnegotiation module coupled to the processor configured to submit theunique patient financial hardship data and the recommended fair marketvalue of the billed medical services to the medical provider forsoliciting a negotiated settlement rate from the medical provider thatis less than the billed medical services; and a communication modulecoupled to the electronic negotiation module configured to transmit thenegotiated settlement rate from the medical provider for the billedmedical services to the medical patient and to provide the medicalpatient with an option to accept and pay the medical provider thenegotiated settlement rate.
 16. The data processing cost and pricedetermination platform of claim 15, wherein the patient medicalnecessity codes include International Classification of Diseases (ICD)diagnosis codes.
 17. The data processing cost and price determinationplatform of claim 15, wherein the updated medical pricing data includeslocal coverage determinations (LCDs) medical pricing and medicalnecessity conditions.
 18. The data processing cost and pricedetermination platform of claim 15, wherein the updated medical pricingdata includes health insurance carrier reasonable and customary fee databased on a prevailing average cost of each service within a medicalprovider geographic region.
 19. The data processing cost and pricedetermination platform of claim 15, wherein the medical billing codescomprises Current Procedural Terminology (CPT) codes.
 20. The dataprocessing cost and price determination platform of claim 15, whereinthe unique patient financial hardship data comprises patient financialhardship questionnaire responses.